Caring for the Older Adult Living in the Community
According to the Centers for Disease Control and Prevention, the number of U.S. adults aged 65 years old or older will more than double to reach about 71 million by 2030. Many of these older adults will continue to live and enjoy life in their communities. Health promotion for older adults living in the community is directed at interventions and services to prolong independence and functional status. This teaching strategy can be used to enhance the learning of students in beginning prelicensure nursing courses. Students will examine older adults’ functional, physical, emotional, and mental health needs using the ACE.S framework. In addition, students will use therapeutic communication skills to assess older adults’ wishes, expectations, cultural traditions, strengths, community resources, and family/caregiver involvement.
Caring for the Older Adult Living in the Community
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- Interact intentionally with older adults living independently in the community.
- Assess and recognize the functional physical, emotional, and mental needs of older adults living in the community.
- Communicate effectively with clients and family.
- Describe the role of the nurse when providing care to older adults in the community.
- Discuss previously held beliefs/assumptions about how older adults live independently in the community.
- Assess older adults’ risks and understand the importance of weighing risks and benefits when caring for older adults.
This teaching strategy focuses on the following ACE.S Essential Nursing Actions: Assess Function and Expectations, Coordinate and Manage Care, and Make Situational Decisions. The strategy enhances the students’ human flourishing, nursing judgment, professional identity, and spirit of inquiry.
- Provide the learners with the ACE.S framework and discuss communication techniques when assessing function and expectations in older adults.
- Review the interview guide and summary for the older adult visit listed under the “Download All Files” section.
- Read the article and watch the video in the Try This:® series focused on evaluating independence related to activities of daily living. Have students think about using this tool as part of an evaluation in assessing the older adult in the community.
- Have students identify an older adult living in a community setting who they can interview.
Suggested Learning Activities
1. Interviewing an older adult living in the community will give the student an opportunity to discuss the needs of an older adult who lives directly in this setting, rather than using an inpatient setting during an acute exacerbation. In the community setting, the student can not only interview the older adult, but can also assess the environmental needs directly, coordinate care as necessary, and discuss situational decisions with the patient and the caregiver(s). Each student will interview an older adult living in the community. Faculty will provide the students with “Student Interview Guide for the Older Adult Visit” and “Student Summary of Visit with the Older Adult” documents.
At the completion of the interviews the students will describe the role of the nurse when providing care to the older adult in the community. The students should be prepared to discuss with the faculty member the older adult’s wishes, expectations, mood, level of independence, life transitions, community involvement, functional status, and cultural traditions.
Students should be prepared to explore other needs that may arise in the interview, such as physical activity, nutrition, tobacco and/or substance abuse, responsible sexual behavior, mental health, safety and injury prevention, environmental quality, immunizations, and access to health care. They should be prepared to discuss other standardized tools that may be helpful in further evaluating the older adult they interviewed based on the content of the interview. The document can be revised to meet specific programmatic and curriculum needs.
2. Assessment Tools. Students should access and use appropriate assessment tools as needed. Some examples of assessment tools that can be used in the community are:
- Katz Index of Independence in Activities of Daily Living (ADL)
- Assessing Nutrition in Older Adults
- The Modified Caregiver Strain Index (CSI)
- 2019 American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
- The Geriatric Depression Scale (GDS)
- Sexuality Assessment for Older Adults
- Alcohol Use and Screening Assessment for Older Adults
3. Concept maps are useful to assess the needs of older adults living in the community, as well as address complex chronic problems that may be occurring. As a group have the students concept map one of the older adults they interviewed in the community. As they are identifying potential risks in this client ask them to think about interventions that could be put in place to both address the risks but also promote independence.
4. Case studies foster students’ critical thinking by illustrating and contextualizing the complexities associated with older adults. For example, ACE.S cases such as George Palo and Red Yoder offer opportunities for students to listen to the voices of these clients living in the community through an audio monologue and discuss interventions to keep them living optimally in their community settings. This approach may be best suited for small group discussions or post-clinical debriefings/discussions.
5. Have the students read the article referenced in the suggested reading section, When Old News Is Good News: The Effect of 6 Elderly New Yorkers on One Middle Aged Reporter and use the following prompts to guide a discussion on older adults living in the community:
- What surprised you most about the older adults in the article who lived in the community?
- How did these older adults compare with pre-conceived notions of older adults?
- What could you learn from these older adults?
Centers for Disease Control and Prevention Aging Publications
The above link provides information and statistics regarding chronic disease and wellbeing of older adults.
Pho, A. T., Tanner, E. K., Roth, J, Greeley, M. E., Dorsey, C. D., & Szanton, S. L. (2012). Nursing strategies for promoting and maintaining function among community-living older adults: The CAPABLE intervention. Geriatric Nursing. 33(6), 439–445. doi:10.1016/j.gerinurse.2012.04.002
Federal Interagency Forum on Aging-Related Statistics. Older Americans 2016: Key Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. Washington, DC: U.S. Government Printing Office. August 2016. https://agingstats.gov/docs/LatestReport/Older-Americans-2016-Key-Indicators-of-WellBeing.pdf
Leland, J. (2018, January 3). The When Old News Is Good News: The Effect of 6 Elderly New Yorkers on One Middle-Aged Reporter. The New York Times. Retrieved from https://www.nytimes.com/2018/01/03/insider/when-old-news-is-good-news-the-effect-of-6-elderly-new-yorkers-on-one-middle-aged-reporter-85-and-up.html
Community College of Philadelphia